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BackgroundBehcet’s disease (BD) is a systemic vasculitis with multiorgan involvement.ObjectivesTo compare the risk of all-cause and cause specific mortality among patients with BD compared to general populationMethodsUsing the 2002-2017 Korea National Health Insurance database, we conducted a cohort study among BD patients compared to general population matched on age and sex at a 1:5 ratio. The primary outcome was death of any cause, and the secondary outcomes were cause-specific mortality for top 5 causes of death. Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs), comparing BD patients versus general population.ResultsThe PS-matched study cohort (mean age 42.1 years; 32.0% male) included 32288 BD patients and 161440 controls. During a mean follow-up of 9.6 years, 2214 deaths occurred. The HR [95%] for all-cause mortality was 10.6 [9.6-11.6]. The Top 5 causes of death derived from malignancy, cardiovascular disease, infection, respiratory disease, and injury: the HR [95%] for mortality from these causes were 8.5 [7.2-10.1], 10.8 [8.6-13.6], 14.6 [8.1-26.3], 12.0 [8.5-17.0], and 8.0 [5.0-13.0], respectively.ConclusionThis population-based cohort study warns exceptionally heavy burden of the disease showing approximately 10 times higher mortality of BD patients compared to general population. In line with this, risk of cause specific mortality was also significantly higher among the BD patients, for 5 top causes of death.Disclosure of InterestsNone declared

BackgroundGout is associated with an increased risk of cardiovascular (CV) disease.ObjectivesTo update comparative CV safety of febuxostat versus allopurinol among patients with goutMethodsUsing the 2011-2019 Korea National Health Insurance database, we conducted a cohort study comparing gout patients initiating febuxostat versus allopurinol, with study participants matched on a propensity score (PS) for>60 covariates at a 1:1 ratio. The primary outcome was composite CV outcome of myocardial infarction, coronary revascularization, and stroke. Secondary outcomes were CV and all-cause mortalities in addition to individual components of the primary outcome. Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs), comparing febuxostat versus allopurinol initiators.ResultsWe included 160,930 febuxostat users PS-matched on 160,930 allopurinol users (mean age 59.3 years, 79.6% male). During a mean follow-up of 250 days, the incidence rate of the primary outcome was 2.27 and 2.06 per 100 person-years for allopurinol and febuxostat users respectively, with the PS-matched HR [95% CI] of 1.03 [0.95-1.12]. Analysis on secondary outcomes also showed a similar result except for all-cause mortality with a significantly reduced risk among febuxostat users with a PS-matched HR [95% CI] of 0.84 [0.78-0.91] (Table 1).Table 1.Comparative cardiovascular safety between febuxostat and allopurinolFebuxostat N = 160,930Allopurinol (Ref) N= 160,930HR (95% CI)EventsPYaIR [95% CI]EventsPYaIR(95% CI]Composite CV endpoint2635128,1932.06 [1.98-2.13]2,09992,5122.27 [2.17-2.37]1.03 [0.95-1.12]MI468129,8730.36 [0.33-0.39]34193,8080.36 [0.33-0.40]1.13 [0.91-1.39]Coronary revascularization1085129,2330.84 [0.79-0.89]85693,2930.92 [0.86-0.98]1.10 [0.96-1.26]Stroke or TIA1490129,1631.15 [1.10-1.21]1,18793,2521.27 [1.20-1.35]0.99 [0.90-1.10]Death2558130,1761.97 [1.89-2.04]2,20194,0072.34 [2.24-2.44]0.84 [0.78-0.91]aIR is per 100 person-years. IR=incidence rate, HR=hazard ratio, CI=confidence interval, MI=myocardial infarction, PY=person-years, TIA=transient ischemic attackConclusionThis large population-based cohort study showed a similar CV safety profile between febuxostat and allopurinol users but found a 16% reduced all-cause mortality among febuxostat users compared to allopurinol, primarily derived from non-CV death reduction.Disclosure of InterestsNone declared

BackgroundThe increased prevalence of rheumatoid arthritis (RA) in women has led to studies exploring how female reproductive factors affect disease outcomes in women RA. While a few studies have investigated how early menopause (EM) affects RA outcomes, they had relatively small sample size and have shown inconsistent results [1, 2]. Moreover, none has evaluated the association between age at menopause and longitudinal changes in validated disease activity indices or patient-reported outcomes (PROs) of RA.ObjectivesWe aimed to assess the differences in clinical outcomes between RA patients with EM (age at menopause MethodsA total of 2,878 postmenopausal women with RA were included from the Korean Observational Study Network for Arthritis, a nationwide prospective RA cohort of Korea. Each patient was examined at baseline and for 5 consecutive years using the simplified disease activity index (SDAI), health assessment questionnaire-disability index (HAQ-DI), and other PROs. Among patients with a baseline SDAI >11, generalized estimating equation (GEE) analyses were performed to evaluate the impact of EM on longitudinal changes in RA activity and PROs during follow-up.ResultsThe EM group (N=437) was younger than the UM group (N=2,441) [58.0±9.5 vs. 60.8±8.0 years, pConclusionRA patients with EM demonstrate higher disease activity and poorer health-related quality of life. EM significantly affects longitudinal changes in disease activity and PROs in RA.References[1]Pikwer M, Nilsson JA, Bergstrom U, et al. Early menopause and severity of rheumatoid arthritis in women older than 45 years. Arthritis Res Ther. 2012 Aug; 14(4):R190.[2]Wong LE, Huang WT, Pope JE, et al. Effect of age at menopause on disease presentation in early rheumatoid arthritis: results from the Canadian Early Arthritis Cohort. Arthritis Care Res (Hoboken). 2015 May; 67(5):616-623.Table 1.Longitudinal analysis of predictors of the SDAI, HAQ-DI, and EQ-5D utility value over time using a GEE model among patients with a baseline SDAI >11OutcomeIndependent variablesRegression coefficient (β) (95% CI)PSDAIAge0.013 (-0.024-0.049)0.503RA duration0.084 (0.046-0.122)Baseline SDAI0.580 (0.531-0.630)Biologic use0.196 (-0.924-1.315)0.732Early menopause1.265 (0.412-2.117)0.004Follow-up time-1.806 (-1.964--1.647)HAQ-DIAge0.007 (0.004-0.009)RA duration0.011 (0.009-0.014)Baseline HAQ-DI0.674 (0.638-0.711)Biologic use0.044 (-0.033-0.122)0.264Early menopause0.092 (0.030-0.154)0.003Follow-up time-0.004 (-0.016-0.007)0.457EQ-5DAge-0.002 (-0.003--0.000)0.007RA duration-0.003 (-0.004--0.002)Baseline EQ-5D utility value0.532 (0.492-0.572)Biologic use-0.012 (-0.045-0.021)0.489Early menopause-0.033 (-0.059--0.006)0.016Follow-up time0.010 (0.005-0.015)Disclosure of InterestsNone declared

Background:Interstitial lung disease (ILD) is a severe extra-articular manifestation of rheumatoid arthritis (RA). However, there are few prospective studies for the natural course of lung physiology in most patients with RA-ILD.Objectives:To assess the natural course of lung physiology of RA-ILD and the relation between arthritis activity and pulmonary physiology in patients with RA-ILD.Methods:The KOrean Rheumatoid Arthritis ILd (KORAIL) cohort is the prospective observational cohort and aims to investigate the natural course of RAILD. Based on either 1987 or 2020 ACR criteria, patients diagnosed with RA and ILD based on CT scan were recruited from six tertiary medical hospitals in Korea since January 2015. RA disease activity was assessed using swollen and tender joint count by treating physician, inflammatory markers including CRP and ESR, and patient’s global assessment annually. Pulmonary function tests (PFT), including FVC, FEV1, DLCO, and chest CT scan, were conducted annually.Results:We analyzed 163 patients at baseline (V1), 141 at 1-year (V2), 122 at 2-year (V3), and 88 at 3-year follow-up (V4). The mean (±SD) duration since RA diagnosis and since ILD diagnosis was 7.6±8.0 and 2.7±3.1 years, respectively. The female to male ratio was about 2:1, and 58.9% of patients (n=96) were 65 years old or older. Only two patients were negative for RF and anti-CCP; 98.7% of patients (n=161/163) were positive for RF (n=143, 87.7%) or anti-CCP antibody (n=154, 94.5%). At enrollment, one-hundred-nine patients (66.9%) had FVC ≥80 % of predicted. Twenty-five patients (15.3%) showed FEV1/FVC≥0.7, of which seventeen patients, only ten percent of a total cohort (10.4%), had FVC ≥80% of predicted, which corresponds to the obstructive pattern. Proportion of patients showed a ≥10-point decline from the enrollment in FVC of the predicted value were around 10% at every year (Table 1). The proportion of patients with a relative decline of ≥10% from the enrollment in FVC predicted was increased every year because of cumulation. The proportion of patients with a relative decline of ≥10% from the previous visit in FVC predicted was also around 10-15% every year. Proportions of patients with 55% or more DLco % pred. has been decreased annually; 78.5% (n=128/158) at V1, 72.9% (n=105/139) at V2, 68.7% (n=90/117) at V3, and 56.6% (n=56/85) at V4. Patients with a relative decline of ≥10% from the enrollment in DLco predicted was 38 (27.5 %) at V2 and 37 (31.9%) at V3. Patients with a relative decline of ≥10% from the previous visit in DLco predicted was 29 (25.2%) at V3. Of note, thirty patients (21.7%) showed a relative 10% or more increase from enrollment in DLco predicted at V2, and so did 30 patients (25.9%) at V3.Table 1.The analysis of forced vital capacity (FVC) in KORIL cohortV1 (enrollment)V2 (1-year)V3 (2-year)V4 (3-year)FVC (mL), mean±SD2549.5 ± 743.32479.5±764.42435.8 ± 742.82405.7 ± 731.2FVC % of predicted, mean±SD84.70 ± 16.7484.7±18.184.3 ± 17.683.1 ± 19.1Rate of FVC decline, mL·year-1 (95% CI)--14 (-49, 21)-62 (-104, -21)-A 10-point decline from V1 in predicted FVC value, n (%)-10 (7.1)16 (13.3)8 (9.4)Relative decline of 10% from V1 in predicted FVC value, n (%)-17 (12.1)23 (18.9)17 (19.3)Relative decline of 10% from the previous visit in predicted FVC value, n (%)-17 (12.1)17 (14.2)13 (15.3)Conclusion:Annually, about 10-15% of patients experience a relative ≥10% decline from the previous visit in FVC predicted value in RA-ILD.Acknowledgements:This work was supported by the Korea Health Technology R&D Project through the Korea Health Industry Development Institute, funded by the Ministry of Health and Welfare, Republic of Korea (grant no.HI14C1277).Disclosure of Interests:None declared

Background:Interstitial lung disease (ILD) is a severe extra-articular manifestation of rheumatoid arthritis (RA). However, the effect of RA treatment on the course of ILD is not yet known.Objectives:To assess the effect of RA treatment on the course of lung physiology of RA-focusing on biologic DMARDs treatment.Methods:The Korean Rheumatoid Arthritis ILd (KORAIL) cohort is the prospective observational cohort and aims to investigate the natural course of RAILD. Based on either 1987 or 2020 ACR criteria, patients diagnosed with RA and ILD based on CT scan were recruited from six tertiary medical hospitals in Korea since January 2015. RA disease activity was assessed using disease activity (DAS)28-ESR and CRP, annually. Pulmonary function tests (PFT), including FVC and DLCO were conducted annually. In the current study, we analyzed patients who completed a 2-years follow-up or had died during those terms till October 2020. They classified patients into three groups: patients treated with abatacept ≥24 weeks ever (Group 1), those with other bDAMRDs ≥24 weeks ever (Group 2), and those without any bDMARDs or with bDMARDs Results:Of a total of 125 patients who completed 2-year follow-up, 21 patients were classified as Group 1, 26 for Group 2, and 78 for Group 3. The mean age or the number of patients with ≥ 65-year-old was comparable between groups(Table 1). The mean duration since RA diagnosis was shorter in Group 3, but that since ILD diagnosis was comparable. DAS28-ESR score was comparable between Group 1 and 2 at enrollment, so was in 1-year-follow-up (p=0.75) and 2-year-follow-up (p=1.00). FVC and % of the predicted value in FVC, FEV1, and DLco were also comparable among the three groups at enrollment. The numbers of patients with ≥10-point decline in % of FVC predicted was 2 (10.0%) for Group 1, 1 (3.8%) for Group 2, 3 (3.9%) for Group3 during the first 1-year follow-up, and 3 (15.8%), 3 (11.5%), 10 (14.1%) during the last 1-year follow up. The percent of FVC predicted was 81.6 ± 17.5 %, 87.4 ± 17.9 %, 85.2 ± 17.7 % for Group 1,2 and 3, respectively, at 1-year-follow-up, and 79.5 ± 18.8 %, 89.0 ± 16.8 %, 83.5 ± 17.3 % at 2-year-follow-up. (Figure 1A). The percent of DLco predicted was 75.5 ± 23.4 %, 66.7 ± 18.1 %, 67.5 ± 16.7 % for Group 1,2 and 3, respectively, at 1-year-follow-up, and 74.0 ± 23.7 %, 69.1 ± 18.9 %, 67.0 ± 18.5 % at 1-year-follow-up (Figure 1B).Conclusion:Treatment of bDMARDs did not exacerbate FVC than without bDMARDs treatment and mitigated the decline of DLCO compared to without bDMARDs treatment during 2-year-follow-up.Table 1.Clinical characteristics at enrollment (V1)TotalGroup 1.Group 2.Group 3.PN125212678Age at enrollment65.9±8.266.0±8.863.9±8.066.6±8.10.3465, n (%)72 (57.6)13 (61.9)11 (42.3)48 (61.5)0.21Female, n (%)89 (71.2)16 (76.2)17 (65.4)56 (71.8)0.71RA duration, years8.0±8.49.6±6.69.2±9.07.2±8.60.05ILD duration, years3.0±3.33.8±3.73.8±3.52.5±3.10.10BMI, kg/m224.1±3.123.8±3.724.8±2.923.9±3.00.39Ever-smoker1855180.57RF positive, n (%)111 (88.8)19 (90.5)22 (84.6)70 (89.7)0.72Anti-CCP positive, n (%)119 (95.2)20 (95.2)25 (96.2)74 (94.9)1.00Arthritis activityDAS28-ESR4.0 ± 1.44.1 ± 1.14.3 ± 1.83.8 ± 1.40.60*DAS28-CRP3.1 ± 1.43.2 ± 1.23.4 ± 1.63.0 ± 1.40.76*HAQ-DI0.70 ± 0.760.64 ± 0.490.82 ± 0.820.67 ± 0.800.28*Pulmonary function testFVC, ml2522.5 ± 765.42406.2 ± 772.62617.3 ± 965.22522.2 ± 692.30.65FVC, % of pred.84.6 ± 16.980.9 ± 17.786.12 ± 17.8285.08 ± 16.50.53FEV1, % of pred.92.4 ± 21.492.0 ± 24.890.6 ± 22.193.0 ± 20.40.88DLco, % of pred.71.5 ± 19.772.3 ± 26.769.1 ± 16.472.0 ± 18.70.80Figure 1.Acknowledgements:This research was supported by Bristol Myers Squibb Inc.Disclosure of Interests:Sung Hae Chang: None declared, Ji Sung Lee: None declared, Jeong Seok Lee: None declared, Chan Ho Park: None declared, Min Uk Kim: None declared, You-Jung Ha: None declared, Eun Ha Kang: None declared, Yeon Ah Lee: None declared, Yongbeom Park: None declared, Jung-Yoon Choe: None declared, Eun Young Lee Grant/research support from: Bristol Myers Squibb Inc.

Background:Interstitial lung disease (ILD) is a severe extra-articular manifestation of rheumatoid arthritis (RA). However, the effect of RA disease activity on the course of ILD is not yet known.Objectives:To assess the natural course of lung physiology of RA-ILD and the relation between arthritis activity and pulmonary physiology in patients with RA-ILD.Methods:The Korean Rheumatoid Arthritis ILd (KORAIL) cohort is the prospective observational cohort and aims to investigate the natural course of RAILD. Based on either 1987 or 2020 ACR criteria, patients diagnosed with RA and ILD based on CT scan were recruited from six tertiary medical hospitals in Korea since January 2015. RA disease activity was assessed using disease activity (DAS)28-ESR and CRP, annually. Pulmonary function tests (PFT), including FVC and DLCO were conducted annually. According to the transition of DAS28-ESR status, we classified patients into four groups: Group A. persistent remission or low disease activity, Group B. improvement, Group C. worsening, Group D. persistent moderate to high disease activity.Results:We analyzed 143 patients who completed a 2-year follow-up (visit 2) or had died with available PFT results at least twice. Mean duration since RA diagnosis and since ILD diagnosis was 7.6±8.0 and 2.7±3.1 years, respectively. Twenty-four patients were Group A, 33 Group B, 10 Group C and 30 Group D. The mean of FVC (mL) and % of the predicted value in FVC was significantly lower in Group D than in other groups (Table 1). The annual rate of decline in FVC was -42 (95% CI -93~10) mL·year-1 in Group B while -113 (95% CI -206~-21) mL·year-1 in Group C (Figure 1A). The annual decline rate in Group C was further exaggerated in patients with ≥ 80% of FVC predicted (-141, 95% CI -251~-32 mL·year-1). During two years of follow-up, patients ever experienced a relative decline of ≥10% from the enrollment in FVC predicted was 27.3%(n-9/33) in Group B whereas 30.0% (3/10) in Group C. The annual rate of decline in % of DLco predicted value was also the largest in Group C (-4.6 %·year-1, 95%CI -8.5~-0.7), which further exaggerated in patients with ≥ 80% of FVC predicted (-4.9%·year-1, 95 %CI -8.3~-1.5, Figure 1B). Of note, about half of patients with maintained not only low disease activity (Group A) but also moderate to severe disease activity (Group D) improved in DLco at least 10% or more from the enrollment of DLco predicted value (Group A: 54.2%, n=13/24, Group D: 46.7%, n=14/30).Conclusion:RA disease activity is associated with the change of lung physiology in patients with RA-ILD; worsening disease activity associated with a further decrease of annual change in FVC and maintaining low disease activity associated with a further increase of annual change in % of DLco predicted value.Table 1.The analysis of forced vital capacity (FVC) according to disease activity transition group.Group AGroup BGroup CGroup DFVC (mL), mean±SD2810.0±771.12528.8±735.32801.0±952.72048.3±575.7FVC % of predicted, mean±SD87.5±14.586.5±16.693.0±15.677.2±17.3Rate of FVC decline, mL·year-1 (95% CI)-52 (-112,7)-42 (-93,10)-113 (-206, -21)1 (-52, 54)A 10-point decline from V1 in predicted FVC value, n (%)29 (20.3)6 (25.0)6 (18.2)3 (30.0)Relative decline of 10% from the enrollment in predicted FVC value, n (%)35 (24.5)5 (20.8)9 (27.3)3 (30.0)Figure 1.The annual change of pulmonary physiology according to disease activity transition group.Acknowledgements:This work was supported by the Korea Health Technology R&D Project through the Korea Health Industry Development Institute, funded by the Ministry of Health and Welfare, Republic of Korea (grant no.HI14C1277).Disclosure of Interests:None declared

Background Leucine-rich alpha2-glycoprotein (LRG) is a protein which contains leucine-rich repeats. Though physiologic functions of LRG have not been clearly defined, its expression was up-regulated during neutrophil differentiation and its levels were significantly elevated in some chronic inflammatory diseases such as inflammatory bowel disease. Objectives Our study aimed to investigate whether serum leucine-rich α2-glycoprotein (LRG) levels are elevated in patients with adult-onset Still's disease (AOSD) and determine their correlation with disease activity parameters. Methods We enrolled 39 patients with AOSD, 39 patients with rheumatoid arthritis (RA), and 39 controls. Forty-five serum samples from the patients with AOSD were assayed for LRG using enzyme-linked immunosorbent assay. Comprehensive AOSD activity was determined by modified Pouchot score. Results Serum LRG levels were significantly elevated in patients with AOSD (128.8±40.8 ng/mL) compared to those in patients with RA and in controls (35.9±15.7 ng/mL, p

Background Recently, a novel scoring system was developed for the diagnosis of gout without joint fluid analysis (1). The performance of this scoring system in the differential diagnosis between acute gout and septic arthritis has not been validated yet. Objectives This study aimed to evaluate the diagnostic performance of this scoring system in the differential diagnosis between acute gout and septic arthritis in patients with acute monoarthritis. Methods The medical records of 33 patients with acute gout and 27 with septic arthritis who presented as acute monoarthritis and were diagnosed at Chung-Ang University Hospital in Seoul, South Korea and Dongguk University Hospital in Goyang, South Korea from 2007 to 2012 were reviewed. Patients with podagra were excluded. All gout patients were MSU positive and all septic arthritis patients had positive results of bacterial culture. The diagnostic scoring system (1) gives different scores to several clinical criteria as follows: 2 to male sex, 2 to previous patient reported arthritis attack, 0.5 to onset within one day, 1 to joint redness, 2.5 to 1 st MTP involvement, 1.5 to hypertension or at least one cardiovasacular disease and 3.5 to serum uric acid greater than 5.88 mg/dL. The probability of gout is high when the sum of the score is ≥ 8, intermediate when between 4 and 8 and low when ≤ 4. Patients were classified to one of each probability groups according to the scores they got. Results Both patient groups were similar in age (55.6±21 vs. 58.4±20.2 years). However, patients with acute gouty arthritis were more likely to be male (90.9% vs. 59.2%), had shorter duration of onset (1.54±1.22 vs.2.92±2.0 days, p=0.004), lower levels of ESR (38.3±73.7mm/hr p=0.001), CRP(7.8±7.0 vs.13.6±9.9 mg/dL, p=0.01), WBC count (9813±2122 vs. 12502±5060/m3, p=0.021) and synovial fluid WBC count (37295±26998 vs. 63210±41211/m3, p=0.014) and had higher levels of serum uric acid compared to those with septic arthritis (7.88±1.8 vs. 5.13±1.7 mg/dL, p Conclusions This novel scoring system showed a good performance in distinguishing between acute gout and septic arthritis. It may be helpful to the primary care physicians when they have to diagnose gout without joint fluid analysis. References Janssens HJ et al. A disgnostic rule for acute gouty arthritis in primary care without joint fluid analysis Arch Intern Med. 2010;170:1120 Disclosure of Interest None Declared

Background Leucine-rich α2-glycoprotein (LRG) is a plasma protein which contains leucine-rich repeats (LRRs). Though physiological functions of LRG have not been clarified yet, it has been reported that LRG could be a marker of granulocytic differentiation and its expression was up-regulated during neutrophil differentiation. LRG could show a significant increase in some inflammatory conditions, such as ulcerative colitis, in where serum LRG concentrations were well correlated with disease activity, and the expressions of LRG were increased in inflamed colonic tissues. However, the association between plasma LRG level and disease activity in RA patients remains obscure. Objectives This study aimed to investigate whether the plasma LRG level is elevated in patients with RA and its correlation with disease activity and other parameters. Methods Our study included 69 patients with RA and 48 age- and sex- matched healthy controls. Plasma samples were obtained from patients with RA during active and inactive disease status and from controls. We assessed the clinical characteristics and laboratory parameters including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and disease activity score 28 (DAS28). Plasma concentrations of tumor necrosis factor-α (TNF-α) and LRG were determined by enzyme-linked immunosorbent assay (ELISA). Results Plasma LRG concentrations were significantly elevated in RA patients compared with healthy control (30.8 ± 14.4 ng/mL vs 22.2 ± 6.1 ng/mL, p γ = 0.671, p γ = 0.612, p γ = 0.601, p p Image/graph Conclusions Patients with RA had higher plasma LRG levels than healthy subjects, and plasma LRG concentrations were well correlated with disease activity measures. Our findings suggest that plasma LRG could play a role in the inflammatory process independently of the TNF- α, and that it may be a novel biomarker for reflecting inflammatory activity in RA patients. References Serada S, Fujimoto M, Terabe F, Lijima H, Shinzaki S, Matsuzaki S, et al. Serum leucine-rich alpha-2 glycoprotein is a disease activity biomarker in ulcerative colitis. Inflamm Bowel Dis 2012;18:2169-79 Shirai R, Hirano F, ohkura N, Ikeda K, Inoue S. Up-regulation of the expression of leucine-rich alpha(2)-glycoprotein in hepatocytes by the mediators of acute-phase response. Biochem Biophys Res Commun 2009;382:776-9 Disclosure of Interest None Declared

Background Chemerin is an adipokine that is linked to adipogenesis and chemotaxis of the innate immune system. It is expressed on macrophage, dendritic cells, and synovial lining and sublining cells. It has been reported that chemerin has both pro-inflammatory and anti-inflammatory roles, and higher level of chemerin was detected in various chronic inflammatory diseases. Recent studies have showed that its expression is increased in the synovium of patients with rheumatoid arthritis (RA), and the chemerin may play an important role in the pathogenesis of RA. However, the association between plasma chemerin level and disease activity in RA patients remains unclear. Objectives This study aims to determine whether plasma chemerin level is elevated in patient with RA and its correlation with disease activity and other parameters. Methods This study includes 69 RA patients and 40 age- and sex- matched healthy controls. Plasma samples were obtained from healthy controls and patients with RA during active and inactive disease status. We assessed the clinical characteristics and laboratory parameters including body mass index (BMI), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and disease activity score 28 (DAS28). The plasma level of chemerin and tumor necrosis factor (TNF)-α were determined using enzyme-linked immunosorbent assay (ELISA). Results Plasma chemerin level was significantly elevated in patients with RA than healthy control (8.508±12.437 pg/mL vs 0.370±0.219 pg/mL, p p =0.049). Conclusions Patients with RA showed higher plasma chemerin than that of healthy controls. The adjusted plasma chemerin level according to BMI was well correlated with RA disease activity. These findings suggest that plasma chemerin could play a role in the inflammatory process of RA, and that it may be a useful disease activity marker in RA. References Kaneko K, Miyabe Y, Takayasu A, Fukuda S, Miyabe C, Ebisawa M et al. Chemerin activates fibroblast-like synoviocytes in patients with rheumatoid arthritis. Arthritis Res Ther 2011;13(5):R158 Nakajima H, Nakajima K, Nagano Y, Yamamoto M, Tarutani M, Takahashi M et al. Circulating level of chemerin is upregulated in psoriasis. J Dermatol Sci 2010;60(1):45-7 Weigert J, Obermeier F, Neumeier M, Wanninger J, Filarsky M, Bauer S, et al. Circulating levels of chemerin and adiponectin are higher in ulcerative colitis and chemerin is elevated in Crohn’s disease. Inflamm Bowel Dis 2010;16(4):630-7 Disclosure of Interest None Declared

Background Various psychological distresses in systemic lupus erythematosus (SLE) may be associated with systemic conditions. However, the influence of psychological distresses to the SLE disease activity still remains unclear. Objectives We evaluated the levels of depression, anxiety, anger and fatigue in patients with SLE, compared to those of healthy controls. We investigated the association between the psychological distresses and disease activity and damage in patients with SLE. Methods 105 patients with SLE and 51 healthy controls completed a psychological questionnaire. Psychological distresses were assessed as follows: depression, Center for Epidemiologic Studies Depression Scale (CES-D); anxiety, Hospital Anxiety and Depression Scale (HADS); anger, State Trait Anger Expression Inventory (STAXI); fatigue, the Profile of Mood States fatigue-inertia Scale (POMS-F). Disease activity and damage index were measured by the SLE Disease Activity Index (SLEDAI) and the SLE Collaborating Clinics/American College of Rheumatology (SLICC/ACR), respectively. Results Patients with SLE showed higher levels of depression ( p =0.003), anxiety ( p =0.049), anger ( p =0.021) and fatigue ( p =0.003) than healthy controls. In the patients with SLE, psychological distresses were well correlated with each other (depression and anxiety: γ=0.712, p p p p p p 7.5 mg/day) had greater symptoms in all of the psychological distresses than the group with lower doses of glucocorticoids (prednisolone ≤7.5 mg/day) (depression, p =0.002; anxiety, p =0.027; anger, p =0.007; fatigue, p =0.016, respectively). However, none of the psychological distresses showed significant differences between higher disease activity and lower disease activity groups, and between higher damage and lower damage groups. In a multiple linear analysis, depression was affected by SLE disease activity (β=0.223, p =0.026) and daily prednisolone doses (β=0.228, p =0.029). However, SLE disease activity was not affected by the psychological distresses. Conclusions SLE patients had more psychological distresses, such as depression, anxiety, anger and fatigue than healthy controls. Higher levels of disease activity and higher use of glucocorticoids affect on depression, while the results do not support that psychological distress affects disease activity status. Disclosure of Interest None Declared

Background Triggering receptor expressed on myeloid cells 1 (TREM-1) is an immunoglobulin-like cell surface receptor mainly expressed on neurtophils, monocytes and macrophages. TREM-1 serves as a critical amplifier of inflammatory signaling, and its expression is increased in the synovium of rheumatoid arthritis (RA) patients. It can exist as a soluble form. However, the association between plasma sTREM-1 levels and disease activity in RA patients remains unclear. Objectives In this study, we investigated whether plasma soluble TREM-1 (sTREM-1) levels are elevated in patients with RA and whether its levels are correlated with disease activity and other parameters. Methods This cross-sectional study included 71 patients with RA and 50 age- and sex- matched healthy controls. Plasma samples were obtained from patients with RA during active and inactive disease status and from controls. We assessed clinical characteristics and laboratory parameters including the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and disease activity score 28 (DAS28). Their plasma levels of sTREM-1 and tumor necrosis factor (TNF)-α were quantitatively measured by enzyme-linked immunosorbent assay (ELISA). Results Patients with RA had significantly higher plasma sTREM-1 levels than healthy controls (170.10±84.71 pg/mL vs 97.41±40.64 pg/mL, p r =0.329, p =0.005; r =0.241, p =0.043; r =0.314, p r =0.261, p =0.028; r =0.278, p =0.019; r =0.313, p =0.009, respectively). Plasma sTREM-1 levels in patients with a active disease status (DAS28 >3.2) were significantly higher than in those with a low disease status (DAS28 ≤3.2) (208.89±100.14 pg/mL vs 150.29±68.70 pg/mL, p =0.005). Conclusions RA patients had higher plasma sTREM-1 levels than healthy controls, and plasma sTREM-1 levels were correlated with disease activity parameters, suggesting that plasma sTREM-1 could play a role in the inflammatory process associated with TNF-α, and that it may be a useful disease activity marker in RA. References Collins CE, La DT, Yang HT, Massin F, Gibot S, Faure G, et al. Elevated synovial expression of triggering receptor expressed on myeloid cells 1 in patients with septic arthritis or rheumatoid arthritis. Ann Rheum Dis 2009;68;1768-74. Kuai J, Gregory B, Hill A, Pittman DD, Feldman JL, Brown T, et al. TREM-1 expression is increased in the synovium of rheumatoid arthritis patients and induces the expression of pro-inflammatory cytokines. Rheumatology 2009:1352-8. Disclosure of Interest None Declared

Background Hyperhomocysteinemia, which is related with cardiovascular diseases and metabolic syndrome, is regarded as one of the important factors in endothelial cell damage processes. It is well known that gout is associated with metabolic syndrome, and cardiovascular diseases are major causes of mortality in gouty patients. However, there are few reports about the serum homocysteine levels in gouty patients, and their results reveal discrepancy. Objectives In this study, we investigated whether or not serum homocysteine levels are elevated in the patients with chronic gout and which factors are associated with the elevated homocysteine levels. Methods This cross-sectional study included 91 male patients with chronic gout and 97 age-matched healthy male controls. The averages of age were 51.19 ± 15.08 and 51.57 ± 17.01 years old, respectively. Serum homocysteine, uric acid (UA), blood urea nitrogen (BUN), creatinine (Cr) and other laboratory findings were tested for all participants. Serum homocysteine levels were measured by a competitive immunoassay using direct chemiluminescent (Siemens Centaur Immunoassay Systems, USA). The estimated glomurular filtration rate (eGFR) was uptained using modification of diet in renal disease (MDRD) formula, then the stages of chronic kidney disease (CKD) were classified according to eGFR levels as follows; stage 1, more than 90 mL/min/1.73m 2 : stage 2, 60-89 mL/min/1.73m 2 : stage 3, 30-59 mL/min/1.73m 2 : stage 4, 15-29 mL/min/1.73m 2 : stage 5, less than 15 mL/min/1.73m 2 . Results The chronic gout group were not significantly different from the control group in serum uric acid levels (6.15 ± 2.23 mg/dL vs 5.82 ± 1.22 mg/dL, p = 0.224). However, the patients with chronic gout showed much higher serum homocysteine levels than healthy controls (13.96 ± 4.05 μmol/L vs 12.67 ± 3.52 μmol/L, p = 0.021). Serum homocysteine levels showed the positive correlations with serum BUN and Cr levels, and the negative correlation with eGFR ( r = 0.429, p r = 0.435, p r = -0.413, p p β = -0.385, p Conclusions Serum homocysteine levels were higher in the male patients with chronic gout than in the healthy male controls. Hyperhomocysteinemia in gouty patients could be related not with serum uric acid levels, but with decreased renal function. Types of uric acid lowering agents did not affect the serum homocysteine levels. Disclosure of Interest None Declared

Background Chemerin is an adipokine that is linked to adipogenesis and chemotaxis of the innate immune system. It is expressed on macrophage, dendritic cells, and synovial lining and sublining cells. It has been reported that chemerin has both pro-inflammatory and anti-inflammatory roles, and higher level of chemerin was detected in various chronic inflammatory diseases. Recent studies have showed that its expression is increased in the synovium of patients with rheumatoid arthritis (RA), and the chemerin may play an important role in the pathogenesis of RA. However, the association between plasma chemerin level and disease activity in RA patients remains unclear. Objectives This study aims to determine whether plasma chemerin level is elevated in patient with RA and its correlation with disease activity and other parameters. Methods This study includes 71 RA patients and 42 age- and sex- matched healthy controls. Plasma samples were obtained from healthy controls and patients with RA during active and inactive disease status. We assessed the clinical characteristics and laboratory parameters including body mass index (BMI), erythrocyte sedimentation rate, C-reactive protein, and disease activity score 28 (DAS28). The plasma level of chemerin and tumor necrosis factor (TNF)-α were determined using enzyme-linked immunosorbent assay (ELISA). Results Plasma chemerin levels were significantly elevated in patients with RA compared with healthy controls (9.074 ± 13.513 ng/mL vs 0.370 ± 0.219 ng/mL, p < 0.001). In RA patients, plasma chemerin levels showed a negative correlation with BMI (γ= -0.264, p = 0.027). Adjusted plasma chemerin levels according to BMI were significantly higher in the active group (DAS28 ≥ 2.6) than in the inactive group (DAS28 < 2.6) (0.591 ± 0.879 ng/mL/Kg/m2 vs 0.220 ± 0.154 ng/mL/Kg/m2, p = 0.015). Plasma chemerin levels adjusted to BMI were correlated with DAS28 (γ = 0.340, p = 0.004), but not with plasma TNF-α levels. Conclusions Patients with RA showed higher plasma chemerin levels than those of healthy controls. Adjusted plasma chemerin levels according to BMI were well correlated with RA disease activity. These findings suggest that plasma chemerin could play a role in the inflammatory process of RA rather than obesity, and that it may be a useful disease activity marker and a candidate target molecule for therapy in RA patients. Disclosure of Interest None Declared